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62 Cards in this Set
- Front
- Back
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what ligament connects liver to anterior abdominal wall
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falciform ligament - contains ligamentum terest & derived from fetal umbilical vein
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what connects liver to duodenum & contains PORTAL TRIAD
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hepatoduodenal
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what is portal triad
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hepatic a, portal v., common bile duct
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what ligament can you compress between thumb & index finger in omental foramen (epiploic foramen of winslow) to control bleeding
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hepatoduodenal ligament
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connects liver to lesser curvature of stomach & contains gastric arteries
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gastrohepatic
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what ligament contains gastroepiploic aa
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gastrocolic - connects greater curvature & transverse colon
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what ligament connects greater curvature of stomach to spleen & what does it contain?
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Gastrosplenic - short gastric aa
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What ligament connects spleen to posterior abdominal wall and what does it contain?
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Splenorenal - splenic a & v.
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what does the mucosa of the digestive tract contain
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epithelium (absorption)
lamina propria (support) Muscularis mucosa (motility) |
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what does the submucosa include?
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Submucosal nerve plexus - Meissners
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what does the muscularis externa contain?
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Myenteric nerve plexus (Auerbach's)
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type of epithelium in esophagus
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nnsk
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histology of stomach
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contains gastric glands
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histology of duodenum
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villi & microvilli to inc absorptive surface
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histology jejunum
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largest goblets, plicae, & cyrpts of Lierberkuhn
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histology of ileum
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peyer's patches (l. propria, submucosa)
Plicae circulares Crypts of Lierberkunn |
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Histology of colon
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Crypts but no villi
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Upper 1/3 of esophagus is what epithelium?
Middle 1/3 Lower 1/3 |
Upper - striated muscle
Middle - striated & smooth Lower 1/3 - smooth muscle |
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what are the 3 branches of the celiac trunk?
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Common hepatic
Splenic Left gastric |
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Common hepatic a branch into what 2 aa
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Gastroduodenal & hepatic a proper
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what are the collateral circulations if abdominal aorta is blocked
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Internal thoracic/mammary --> superior epigastric --> inferior epigastric
Superior pancreaticoduodenal (celiac) --> inferior pancreaticoduodenal (SMA) Middle colic (SMA) --> Left colic (IMA) Superior rectal (IMA) --> Middle rectal (internal iliac) |
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what are ways to relieve portal HTN
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insert portocaval shunt between splenic & left renal v. or connecting portal v. to IVC
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what is the arterial supply & venous drainage above the pectinate line?
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Arterial - superior rectal artery
Venous - superior recetal v --> inferior mesenteric v --> portal system |
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What is arterial supply & venous drainage below the pectinate line
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Arterial - inferior rectal artery
Venous - inferior rectal vein --> internal pudendal vein --> internal iliac v. --> IVC Nerve - inferior rectal nerve (branch pudendal) |
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site of indirect hernia & relationship to epigastric vessels
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Lateral to epigastric vessels & protrudes from internal (deep) inguinal ring to external inguinal ring & INTO scrotum. occurs in infants owing to failure of processus vaginalis
Follows the path of descent of the testes - covered by all 3 layers of spermatic fascia |
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site of direct hernias & relationship to epigastric vessels
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Medial to epigastric vessels , protrudes through abdominal wall - inguinal (Hesselbach's) triangle. Goes through external inguinal ring ONLY covered by external spermatic fascia
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protrudes below inguinal ligament through femoral canal below & lateral to pubic tubercle. More common in women
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Femoral hernia
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what makes up hesselbachs triangle
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Inferior epigastric artery ( superior border)
Lateral border of rectus abdominis (medial border) Inguinal ligament (lateral border) |
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what cells secrete gastrin?
fxn of gastrin? |
G cells of antrum of stomach
Inc gastric H secretion, Inc growth gastric mucosa, Inc gastric motility Inc by stomach distention, aa (PEHNYLALANINE & TRYPTOPHAN), peptides, vagal stimulation Dec by stomach pH <1.5 |
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What secretes CCK? Fxn? REgulation?
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I cell secretes - duodenum, jejunum
Fxn: Inc pancreatic secretion, inc gallbladder contraction, dec gastric emptying Regulation: inc by fatty acids, amino acids |
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What do the S cells of the duodenum secrete - what is their fxn
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Secretin -- increases pancreatic secretion, dec gastric acid secretion, inc bile secretion
Secretin secretion is inc by acid, fatty acids in lumen of duodenum |
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D cells of pancreatic islets & GI mucosa secrete what? What's that fxn?
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Somatostatin -- BIG INHIBITOR - dec gastric acid & pepsinogen secretion, dec pancreatic & small intestine fluid secretion, dec gall bladder contraction, dec insulin & glucagon release
Somatostatin secretion is inc by acid & dec by vagal stimulation Antigrowth hormone - digestion & absorption of substances needed for growth |
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K cells of duodenum & jejunum secrete what?
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GIP - glucose dependent insulinotropic peptide (GIP)
Exocrine - dec gastric H secretion Endocrine -- inc insulin release |
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what is the source for vasoactive intestinal polypeptide (VIP)
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Parasympathetic ganglia in sphincters, gallbladder, small intestine
Inc intestinal water & electrolyte secretion (VIPoma -- copious diarrhea) Inc relaxation of intestinal sm muscle & sphincters |
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loss of what secretion is implicated in inc lower esophageal tone of achalasia
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Nitric oxide
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what hormone inc GH, ACTH, cortisol, & PRL secretion, is lost following gastric bypass & a/w hyperphagia in prader willi?
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Ghrelin
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what do the chief cells of the stomach secrete
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pepsin - protein digestion, inc by vagal stimulation & local acid
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results from partial closure of vitelline duct w/ patent portion attached to ileum & fibrous band connected to umbilicus
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Meckel's diverticulum
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cystic dilatation of vitelline duct
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Omphalomesenteric cyst
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what GI pathology do you see in Down's pts
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Hirschprung
Duodenal atresia Annular pancreas Celiac disease |
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MCC of SBO
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A - adhesions from previous surgery
B - bulge/hernia C - cancer/tumors/mets Others: volvulus, intussuception, chrohns, gallstone ileus, bezoar, bowel wall hematoma, stricture, congenital radiation/enteritis |
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what are the sx of carcinoid syndrome
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B - bronchospasm
F - flushing D - Diarrhea R - rt sided heart disease |
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extrahepatic biliary obstruction (gallstone, biliary stricture, chronic pancreatitis, carcinoma of pancreatice head) --> inc pressure in intrahepatic ducts _-> injury/fibrosis and bile stasis
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secondary biliary cirrhosis
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Presents with pruritus, jaundice, dark urine, light stools, HSM
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Secondary biliary cirrhosis
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Inc conjugated bilirubin, inc cholesterol, inc alk phos, complicated by ascending cholangitis
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secondary biliary cirrhosis
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autoimmune rxn --> lymph infiltrate + granulomas, inc serum mitochondrial ab; florid duct lesions --> destruction of interlobular ducts by granulomatous inflammation
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Primary biliary cirrhosis
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Inc serum mitochondrial abs; a/w other autoimmune conditions (CREST) - rheumatoid arhtirtis, celiac disease
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Primary biliary cirrhosis
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middle aged female with new onset pruritis
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primary biliary cirrhosis
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unknown cause of concentric onion skin bile duct fibrosis --> alternating strictures with dilation with beading of intra & extrahepatic bile ducts on ERCP; men in 40s
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Primary sclerosing cholangitis
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+ ANA, ASMA, RF, p-ANCA, hyperIgM, a/w ulcerative colitis; can lead to secondary biliary cirrhosis
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Primary sclerosing cholangitis
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Charcot's triad of cholangitis
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Jaundice
Fever RUQ pain |
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Reynold's pentad
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Jaundice
Fever RUQ pain Hypotension Altered mental status |
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these gallstones are seen in pts w/ chronic hemolysis, alcoholic cirrhosis, advanced age & biliary infection
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pigmented stones
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what is the pathogenesis behind gallstone ileus
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fistula between gallbladder & small bowel so gallstone can obstruct ileocecal valve --> see air on biliary tree on imaging
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Risk factors for acute pancreatitis
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G- Gallstones
E- Ethanol T - Trauma S - Steroids M - Mumps A - Autoimmune S - Scorpion Sting H - Hypercalcemia/Hyperlipidemia E - ERCP D- Drugs (didanosine, stavudine, propafol, zacitabine, ritonavir) |
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tumor markers for pancreatic cancer
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CEA & CA19-9
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obstructive jaundice with palpable gallbladder
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Courvoisier's sign in pancreatic adenocarcinoma
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which antacid causes constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
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Aluminum hydroxide - MINIMUM amt of feces
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what antacid causes diarhea, hyporeflexia, hypotension, & cardiac arrest
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Mg Hydroxide - Must go to bathroom
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what antacid causes hypercalcemia, rebound acid
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Calcium carbonate
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combo of sulfapyridine & 5-aminosalicyclic acid that is activated by colonic bacteria used in UC & Chrohns
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Sulfasalazine
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drug used in diabetic & post surgery gastroparesis by blocking D2 receptor & agonizing 5HT4 receptor
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Metoclopramide - inc resting tone, contractility, LES tone, motility (doesn't influence colon transport time)
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